Food Handling Permit Application
Completed applications should be forwarded to your local Environmental Public Health Office
Reason for Application
o New Business
o Change of Ownership
Effective Date (yyyy-Mon-dd)
o Change of Location
o Other
Contact Information
Name of Owner(s)
Name of Operator/Manager
Phone
Extension
Phone
Extension
Email
Email
Legal Business Information
Trade Name of Establishment/Business
Franchise Number (if applicable)
Business Ownership Name (e.g. 123456 AB Ltd.)
Establishment/Operating Location
Facility Address
Unit/Suite Number
Rural Land Location (choose one if applicable)
Lot
Block
Plan
Quarter (choose one): o SE
Section
o SW
Township
o NE
Range
City/Municipality
Postal Code
Mailing Address
Address
West of
Meridian
Province
Phone
o Same as above
OR
City/Municipality
Billing Address
Address
o NW
Fax
o send all correspondence to:
Attention
Province/State
o Same as above
OR
Postal Code
o send invoice to:
Attention
City/Municipality
Province/State
Postal Code
Email
Phone
Fax
03298 (Rev2017-02)
Food Handling Permit Application
Base of Operation/Storage Location - Mobile Units and Water Haulers Only
Base of Operation Address
Rural Land Location (choose one if applicable)
Block
Lot
Quarter (choose one):
Section
o SE
Township
Plan
o SW
o NE
Range
West of
City/Municipality
Tank ID
o NW
Meridian
Vehicle Identification Number
License Plate
AHS Decal Number (if known)
Has the water hauling truck been used to haul any products other than potable water?
o Yes
o No
Please include information for additional units on an additional page and submit it with this application.
Operational Period (choose one)
o Annual
OR
o Seasonal 4 If Seasonal, check the months of operation
o January
o February
o May
o June
o September
o October
o March
o July
o November
o April
o August
o December
Choose one if applicable
o Registered Charity
(If checked, provide Canadian Revenue Agency Registered Charity Number)
o Alberta Registered Non-Profit Facility (provide a copy of the first 2 pages of your Annual Tax Return)
I, the undersigned, certify that the information provided on this form is true and correct
Print Name
Title
Signature
Date (yyyy-Mon-dd)
For Environmental Public Health Office Use Only
Comments
Inspector Name
Facility Number
Date Received (yyyy-Mon-dd)
Fee Class
03298 (Rev2017-02)
Food Handling Permit Application
Submit your completed application to the appropriate area below. For your reference, a map is provided
outlining the zones.
North Zone
Environmental Public Health
10320 99 Street,
Grande Prairie, AB T8V 6J4
Fax 780.532.1550
Alberta Health Services
Phone 780.513.7517
Zone Map
[email protected]
Edmonton Zone
Environmental Public Health
Safe Food HSBC Building
700 - 10055 106 Street
Edmonton, AB T5J 2Y2
Fax 780.735.1802
Phone 780.735.1763
[email protected]
Boyer
High
Level
Beaver
Ranch
Child
Lake
Manning
North Zone
Fort
McMurray
Grimshaw
Peace
River
Fairview
Central Zone
Environmental Public Health
Red Deer Johnstone Crossing
300 Jordan Parkway
Red Deer, AB T4P 0G8
Fax 403.356.6433
Phone 403.356.6366
[email protected]
Calgary Zone
Environmental Public Health
10101 Southport Road SW
Calgary, AB T2W 3N2
Fax 403.943.8056
Phone 403.943.8053
[email protected]
Spirit
River
Wabasca
McLennan
High
Prairie
Beaverlodge
Grande
Prairie
Slave
Lake
Valleyview
Lac La Biche
Athabasca
Fox
Creek
Cold
Lake
Swan
Hills
Bonnyville
Barrhead
Whitecourt
Grande
Cache
Edmonton
Zone
Smokey
Lake
Westlock
St. Paul
Mayerthorpe
Fort
Saskatchewan
Edson
Hinton
Jasper
Central Zone
Two
Hills
Lamont
St. Albert
Spruce Grove
Vegreville
Edmonton
Stony
Tofield
Plain Beaumont
Drayton
Viking
Leduc
Valley
Camrose
Wetaskiwin
Daysland
Rimbey
Ponoka
Bashaw
Lacombe
Rocky
Mountain
Stettler
Red
House
Castor
Deer
Innisfail
Sundre
Three
Hills
Olds
Didsbury
South Zone
Environmental Public Health
River Heights Professional Centre
200 – 88 Valleyview Drive SW
Medicine Hat, AB T1A 8N6
Fax 403.502.8256
Phone 403.502.8205
[email protected]
or
Environmental Public Health
801 1 Avenue South
Lethbridge, AB T1J 4L5
Fax 403.328.5934
Phone 403.388.6689
03298 (Rev2017-02)
Canmore
Calgary Zone
Wainwright
Provost
Coronation
Hanna
Oyen
Airdrie
Cochrane
Chestermere
Calgary
Black
Diamond
Lloydminster
Drumheller
Cremona
Banff
Vermilion
Okotoks
Turner
Valley
Strathmore
Bassano
Brooks
High
River
Vulcan
Medicine
Hat
Nanton
Bow
Island
Claresholm
Crowsnest
Pass
South Zone
Lethbridge
Taber
Fort
Raymond
MacLeod
Pincher
Magrath
Milk
Creek
River
Cardston